Job Overview

Claims Examiner will be responsible and accountable to support organizational goals and follow all processes with a focus on Claims Adjudication.

Responsibilities and Duties:

• Receiving calls about health care insurance coming from network providers
• Review of claims based on provider and health plan contractual agreements, claims processing guideline, reviewing duplicate claims and coordinating benefits (COB) with other health insurance
• Review of manual processing to ensure accuracy and timeliness of claims processing
• Accountable to support company’s goals and follow all set processes
• Using DOFR-Division of Financial Responsibility – Identify claims that are not our clients financial risk
• Verify patient’s accounts for eligibility and benefits
• Read, interpret and summarize provider contracts
• Validate paper claims data against system data for accurate data capture
• Adjudicate claims in accordance with department policies and procedures and other business rules

Minimum Requirements:

• Bachelor’s Degree of any field
• 1-2 years experience on Medical Claims Processing
• Knowledgeable with HMO Plans
• Working knowledge of Microsoft Office products
• Average to excellent verbal and written communication skills
• Be able to receive direction and training on extensive claim adjudication
• All other duties as assigned
• Amenable to work in BGC, Taguig
• Can Start ASAP

APPLY NOW! Walk-in at 10F Bench Tower Rizal Drive cor 30th St BGC Taguig I 11AM - 5PM I Bring a valid ID.